Question Of The Day: Respiratory Disorders

Q. A client with a tracheostomy tube coughs and dislodges the tracheostomy tube. The nurse's first action should be to:

A. Call for emergency assistance.
B. Attempt reinsertion of tracheostomy tube.
C. Position the client in semi-Fowler's position with the neck hyperextended.
D. Insert the obturator into the stoma to reestablish the airway.

Correct Answer: B
Explanation: The nurse's first action should be to attempt to replace the tracheostomy tube immediately so that the client's airway is reestablished. Although the nurse may also call for assistance, there should be no delay before attempting reinsertion of the tube. The client is placed in a supine position with the neck hyperextended to facilitate reentry of the tube. The obturator is inserted into the replacement tracheostomy tube to guide insertion and is then removed to allow passage of air through the tube.

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Nurses vs. Other Careers: Similarities And Differences

Choosing a career can be a difficult decision for many people, especially if one of the considerations is nursing. Yes, it's a lucrative and fulfilling career for most people who enter the field, but it's by no means an easy one. You'll have to develop patient care skills and become licensed, for one, but you'll also have to wear a number of different hats once you're on the job.

If you're doing some career exploration, or torn between a few different professions, comparing their parallels and differences to nursing might help you make your final decision.

Take a look as we pit nurses against a number of popular career paths you might be contemplating. You may be surprised at some of the similarities, or swayed by the characteristics that make nursing unique and special.

NURSES VS. TEACHERS

Because these are two careers that focus on helping others, and providing some form of care, in many ways, nurses and teachers aren't all that different. Both roles require dealing with people from all walks of life, working as part of a team, and following some sort of an established system of best practices. Nurses also act as educators when they have to teach patients and family members how to manage their own care.

What's more is that both jobs require licensing and offer advancement opportunities and specializations if you're willing to pursue graduate studies.

The big difference here, besides the type of work setting, are the hours. Teachers usually work an academic-year, school-day schedule, while nurses work year round and oftentimes, nights, weekends, and holiday.

Best of both worlds : If you're truly torn, there are a couple of ways to combine your passion for education with nursing. One is you can become a school nurse, an RN who cares for injuries and illnesses that happen to students during the school day.The other is to become a nurse educator, teaching nursing students.

NURSES VS. LAW ENFORCEMENT

If you are excited by the idea of looking for clues, gathering evidence, and solving problems, that can easily be applied to both nursing and police work. While the heart of your job as a nurse is patient care, you will likely spend part of your day doing diagnostic exams, asking questions, and reporting back to your medical team – kind of how a detective investigates a case.

The major difference between these two worlds is that you're likely dealing with a higher degree of danger in law enforcement. But, you probably don't need as much formal education to move up the ranks.

Best of both worlds : A great way to combine your two interests is to become a legal nurse consultant or a forensic nurse. Both of these specializations put you at the center of legal or criminal cases, while still relying on your medical expertise. Legal nurse consultants provide expert testimony and assistance to legal teams; forensic nurses deal exclusively with victims of violent crimes, and may also be called upon to testify.

NURSES VS. FIREFIGHTER

Both of these professionals put out fires – just different kinds. In other words, both nurses and firefighters must deal with high stress situations that could involve life and death. What's more is that many firefighters are also trained as paramedics, so they are trained in how to administer first-aid and emergency care.

Obviously, both occupations are 24/7, but there is a much higher physical requirement and potential for personal injury as a firefighter. Nursing, however, requires more formal education, although some fire departments do seek candidates that have college credits.

Best of both worlds : If your ideal nursing job is one that is action-packed and fast-paced, you can work your way into an emergency room or trauma unit. There are also military nurses who provide on-scene care to soldiers, sometimes even in war zones.

NURSES VS. SOCIAL WORKER

If the main career goal is to help others, it's no wonder why you'd be torn between these two very noble professions. Social workers help people through a variety of life challenges, some of which aren't related to medical conditions. With nursing, you're primarily involved in the health outcomes of a patient.

The other major difference is compensation. Social workers typically earn a lot less than nursing professionals, even though many of them must attain a bachelor's degree or even a master's degree to work in the field.

Best of both worlds : If you truly want to advocate for your patients, one way to do that and still be a nurse is to become a Nurse Case Manager. In this role, you're the liaison between the patient and the care solutions providers needed for long-term recovery. On the social work side, if you become a Clinical Social Worker (versus non-clinical), you'll get to be more hands-on with helping families deal with serious illness, substance abuse, and domestic conflict.

As you can see, becoming a Registered Nurse comes with many of the same responsibilities as professionals in other fields. The very nature of the job requires you to be a good communicator and teacher, a person who can gather information and make smart decisions, someone who can deal with stressful situations, and a person who cares deeply for the well-being of others.

Thanks to the many specializations within the nursing profession, there are lots of opportunities to dip your toe into other fields so you don't necessarily have to choose one over the other.

What your decision really comes down to is whether or not you enjoy the basics of nursing, and if you can find a way to make it fit your lifestyle and interests. 

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Question Of The Day: Neurosensory Disorders

Q. A nurse on a rehabilitation unit is caring for a client who sustained a head injury in a motor vehicle accident. She notes that the client has become restless and agitated during therapy; previous documentation described the client as cooperative during therapy sessions. The nurse's priority action should be to:

A. gather assessment data and notify the physician of the change in the client's status.
B. ask the physician to order an antipsychotic medication for the client.
C. consult with the social worker about the possibility of discharging the client from the facility.
D. tell the client that she'll punish him if he doesn't behave.

Correct Answer: A
Explanation: A client with a head injury who experiences a change in cognition requires further assessment and evaluation, and the nurse should notify the physician of the change in the client's status. The physician should rule out all possible medical causes of the change in mental status before ordering antipsychotic medications or considering discharging the client from the facility. A nurse shouldn't threaten a client with punishment; doing so is a violation of the client's rights.

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The Meaning Behind Nursing Titles

In terms of educational options related to the nursing profession, there are a plethora of programs available to students. It is important to understand all of the available alternatives and determine which program or advanced degree fits your career goals and lifestyle. According to the Henry J. Kaiser Family Foundation, there are currently 3.1 million active registered nurses and approximately 800,000 licensed practical nurses in the United States.

LPN or LVN Degree

The quickest way to enter the nursing workforce is to become a licensed practical nurse (LPN) or licensed vocational nurse (LVN). These programs usually take a year to complete and can be done through local community colleges, vocational/technical schools, or hospital-based programs. This option is convenient for those who work or have families. Additionally, some courses can be taken online or during the summer, which gives students greater flexibility. These programs are faster paced than other nursing programs and only teach basic nursing skills vs. in-depth science and nursing classes.

While this may be the quickest avenue to enter the nursing profession, the use of LPNs is being phased out. In many facilities, LPNs are being replaced with Registered Nurses (RN) who hold Bachelors of Science in Nursing (BSN) degreesor those with Associates Degrees in nursing. Furthermore, LPNs have a smaller scope of practice than RNs. The scope of practice is determined by each state, and LPNs may or may not be able to:

■ Take verbal or phone orders from a doctor
■ Administer narcotics
■ Care for central intravenous lines
■ Administer medications that are given via intravenous push

According to the U.S. Bureau of Labor Statistics, LPNs can earn annual salaries as low as $33,300 in West Virginia, and up to $53,010 in Connecticut. LPNs average approximately $20 per hour. Fortunately, as LPNs are being phased out of hospital settings in some states, they are still able to find employment in nursing homes, rehabilitation centers, and home care.

Bachelor of Science in Nursing (BSN)

Obtaining a BSN requires a commitment to a four-year program through an accredited university. Some students enter these programs after completing high school. Nurse hiring committees often favor candidates with a BSN degree; nurses with their BSN will usually have better job opportunities and the potential to earn higher salaries.

BSN programs are a combination of lecture-based classes and clinical rotations completed at a local hospital or other medical facility. Nurses that plan on advancing their career and obtaining higher education degrees will need a BSN in order to enter those advanced programs. After completing a BSN program, students are able to sit for the National Council Licensure Examination (NCLEX) to become a registered nurse. A student needs to pass this exam before practicing as an RN.

Registered Nurse (RN)

A registered nurse is a nurse who has graduated from an accredited nursing program with a BSN, associate degree in nursing (ADN), or diploma from a hospital-based program in nursing. To obtain an RN license, an individual needs to pass the NCLEX in the state where they wish to obtain licensure. Students also need to check with their state of residence since some states have additional criteria for licensure. RNs are able to hold licenses in multiple states at the same time. A nurse is only required to pass the NCLEX once and then may apply for a license to practice in other states after the initial licensure.

Nurses are responsible for administering medication, monitoring patients' conditions, documenting nursing care, notifying medical staff about patient progress of the patient, and performing medical procedures that are within their scope of practice.

According to The U.S Bureau of Labor Statistics Occupational Outlook Handbook for 2016-17, the median expected annual salary for RNs is $66,640. California has the largest number of active registered nurses with an annual mean salary of $102,260. California, Alaska, Hawaii, Oregon, and Massachusetts have the highest mean salaries for nurses; however, they do vary within each state. West Virginia, Alabama, Mississippi, South Dakota, and Iowa have the lowest mean salaries for RNs.

Nurse Practitioner (NP)

Nurse Practitioners (NP) are advanced practice nurses (APRNs) who have taken masters-level classes and passed the American Academy of Nurse Practitioners Exam. Nurse Practitioners can specialize in adult, geriatric, pediatric, family, or women's health; within each of these specialties, a Nurse Practitioner can specialize even further. For example, a pediatric nurse practitioner (PNP) can specialize in cardiac care, intensive care, oncology, or become a general practitioner, to name a few. These subspecialties require additional classes and on-site training, and with more specialization comes potentially higher salary opportunities.

To become a nurse practitioner, one has to first be a current registered nurse. RNs interested in advancing their careers must apply to a graduate program that offers their specific program of interest. Applicants are required to submit resumes and letters of recommendation, as well as transcripts from their undergraduate education. Some programs require an applicant to take the GMAT (Graduate Management Admission Test) as well. NP programs generally require 2-3 years as a full-time student or 5 years if completed on a part-time basis.

The American Academy of Nurse Practitioners (AANP) released a statement, revised in 2015, outlining the scope of practice for an NP. "Nurse practitioners assess, diagnose, treat, and manage acute, episodic and chronic illnesses. NPs are experts in health promotion and disease prevention. They order, conduct, supervise, and interpret diagnostic and laboratory tests, prescribe pharmacological agents and non-pharmacologic therapies, as well as teach and counsel patients, among other services." The AANP acknowledges that these practices will vary among individual states and institutions.

As of May 2015, the U.S Bureau of Labor Statistics reported the median salary for NPs was $98,190. California registered the highest median salary for NPs at $120,930. Currently, California, Hawaii, Alaska, Massachusetts, and Oregon have the highest median salaries for NPs. Pennsylvania, Kansas, South Carolina, Missouri, and Illinois have the lowest median salary for nurse practitioners.

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Question Of The Day: Gastrointestinal Disorders

Q. A client with gastroenteritis is admitted to an acute care facility and presents with severe dehydration and electrolyte imbalances. Diagnostic tests reveal the Norwalk virus as the cause of gastroenteritis. Based on this information, the nurse knows that:

A. the client requires an antiviral agent.
B. enteric precautions must be continued.
C. enteric precautions can be discontinued.
D. the client's infection may be caused by droplet transmission.

Correct Answer: B
Explanation: The nurse must continue enteric precautions for a client with gastroenteritis caused by the Norwalk virus because this virus is transmitted by the fecal-oral route. No safe and effective antiviral agent is available specifically for treating viral gastroenteritis. The Norwalk virus isn't transmitted by droplets.

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Question Of The Day: The Neonate

Q. Just after delivery, a nurse measures a neonate's axillary temperature at 94.1° F (34.5° C). What should the nurse do?

A. Rewarm the neonate gradually.
B. Rewarm the neonate rapidly.
C. Observe the neonate hourly.
D. Notify the physician when the neonate's temperature is normal.

Correct Answer: A
Explanation: A neonate with a temperature of 94.1° F is experiencing cold stress. To correct cold stress while avoiding hyperthermia and its complications, the nurse should rewarm the neonate gradually, observing closely and checking vital signs every 15 to 30 minutes. Rapid rewarming may cause hyperthermia. Hourly observation isn't frequent enough because cold stress increases oxygen, calorie, and fat expenditure, putting the neonate at risk for anabolic metabolism and possibly metabolic acidosis. A neonate with cold stress requires intervention; the nurse should notify the physician of the problem as soon as it's identified.

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Nurse manager vs. Nurse leader: What's the difference?

Nursing is a call to leadership

By its very nature, the professional nurse role is one of leadership. Across the healthcare continuum, regardless of our role or practice setting, we are looked to as leaders. As nursing students, we are taught we will lead colleagues from other ancillary groups, oversee care teams and be accountable for patient care outcomes. Some nurses spend years leading in an informal leadership capacity, while others take on formal management and leadership roles. However, all management and leadership roles are not the same, and although the titles often are used interchangeably, they are not synonymous.

The nurse manager role up close

Whether managing a unit, division or service line, at its core the nurse manager role is to ensure everything functions like a well-oiled machine. The nurse manager is involved in myriad daily tasks and details related to patient care planning, quality improvement, goal setting and budgeting. But that’s not all. Nurse managers also oversee staff schedules and assignments, performance, professional growth and the ongoing provision of educational and career enhancement opportunities. The manager is responsible for ensuring the staff carries out all assignments and is held accountable if they’re not.

And staff members — nurses, CNAs, techs, etc. — have certain expectations for their nurse managers. They look to their managers for clear communication, direction and support in fulfilling their roles and responsibilities. They also want their managers to be available, open and honest. Nurse managers are their source for information, advice and guidance, but they also want — and deserve — encouragement, clear expectations and directions, and some teaching and coaching. Most of all, they want to be included in decision-making, recognized for their contributions and considered important to the team.

“Nurse managers are their source for information, advice and guidance, but they also want — and deserve — encouragement, clear expectations and directions, and some teaching and coaching.”

The nurse leader role up close

Upper level nurse leaders, in most instances, are less task-oriented than nurse managers. They are less hands-on and more focus on setting standards, spearheading transformation and inspiring and influencing their teams. They are charged with fulfilling the organization’s mission, vision and strategic long-range plans.

Their role involves policy setting and overseeing quality measures; dealing with regulatory compliance, certainly taking on fiscal responsibilities and more. They have responsibility and accountability for the overall quality of patient care delivery, patient and staff satisfaction, and organizational outcomes.

Both staff and management look to them for their knowledge, experience and vision. Their role is an expansive one that touches the entire organization.

Managers and leaders complement each other

Managers function best in the company of good leaders, but both roles should be filled by individuals who earn the respect and admiration of their staff, are passionate about their work and instill that passion in their staff. Both managers and leaders:

Must be motivators who positively influence their staff and set positive examples.
Must have excellent decision-making skills — able to coordinate teams and delegate duties.
Must be committed to the organization and those they lead.

Title aside, all nurses are called to leadership

The call to leadership moves all of us to a higher plane of responsibility and accountability, with or without a management title; it is inherent in all nursing positions from staff nurse to CEO. We all have similar goals and responsibilities for patient care.

“The call to leadership moves all of us to a higher plane of responsibility and accountability, with or without a management title; it is inherent in all nursing positions from staff nurse to CEO.”

With all the changes currently underway in our healthcare delivery system and the nursing profession, all nurses must strive to emulate the hallmarks of good management and leadership and never stop working on our professional growth. We all need to stay informed and be politically saavy; we need to know what our professional journals and nursing organizations are saying and advance our education.

In the end, all nurses must be visionaries, critical thinkers, skilled communicators and teachers. And the good news is you do not need a formal manager or leader title required to do any of these things.

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Question Of The Day: Postpartum Period

Q. A client is experiencing an early postpartum hemorrhage. Which item in the client's care plan requires revision?

A. Inserting an indwelling urinary catheter
B. Fundal massage
C. Administration of oxytocics
D. Pad count

Correct Answer: D Explanation: By the time the client is hemorrhaging, a pad count is no longer appropriate. Inserting an indwelling urinary catheter eliminates the possibility that a full bladder may be contributing to the hemorrhage. Fundal massage is appropriate to ensure that the uterus is well contracted, and oxytocics may be ordered to promote sustained uterine contraction.

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Question Of The Day: School-age Child

Q. On initial assessment of a 7-year-old child with rheumatic fever, which of the following would require contacting the primary care provider immediately?

A. Heart rate of 150 beats/minute.
B. Swollen and painful knee joints.
C. Twitching in the extremities.
D. Red rash on the trunk.

Correct Answer: A

Explanation: A heart rate of 150 beats/minute is very high for a 7-year-old child and may indicate carditis. For this age group, the normal heart rate while awake is 70 to 110 beats/minute. Swollen and painful joints such as the knee are characteristic findings in the child with rheumatic fever and do not require immediate physician notification. Twitching in the extremities, known as chorea, is a characteristic finding in a child with rheumatic fever and does not require immediate physician notification. A red rash on the trunk typically indicates rheumatic fever and does not require immediate physician notification.

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Question Of The Day: Infant

Q. The nurse is assessing the development of a 7-month-old. The child should be able to:  

A. Play pat-a-cake.
B. Sit without support.
C. Say two words.
D. Wave bye-bye. 

Correct Answer: B
 

Explanation: The majority of infants (90%) can sit without support by 7 months of age. Approximately 75% of infants at 10 months of age are able to play pat-a-cake. The ability to say two words occurs in 90% of children by age 16 months. A child typically can wave bye-bye at about 14 months of age.

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Question Of The Day: Medication and I.V. Administration

Q. Total parenteral nutrition (TPN) is prescribed for a client who has recently had a significant small and large bowel resection and is currently not taking anything by mouth. The nurse should:

A. Administer TPN through a nasogastric or gastrostomy tube.
B. Handle TPN using strict aseptic technique.
C. Auscultate for bowel sounds prior to administering TPN.
D. Designate a peripheral intravenous (IV) site for TPN administration.

Correct Answer: B
Explanation: TPN is hypertonic, high-calorie, high-protein, intravenous (IV) fluid that should be provided to clients without functional gastrointestinal tract motility, to better meet their metabolic needs and to support optimal nutrition and healing. TPN is ordered once daily, based on the client's current electrolyte and fluid balance, and must be handled with strict aseptic technique (because of its high glucose content, it is a perfect medium for bacterial growth). Also, because of the high tonicity, TPN must be administered through a central venous access, not a peripheral IV line. There is no specific need to auscultate for bowel sounds to determine whether TPN can safely be administered.

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Question Of The Day: Basic Physical Care

Q. The nurse observes that the right eye of an unconscious client does not close completely. Which nursing intervention is most appropriate?

A. Have the client wear eyeglasses at all times.
B. Lightly tape the eyelid shut.
C. Instill artificial tears once every shift.
D. Clean the eyelid with a washcloth every shift.

Correct Answer: B

Explanation: When the blink reflex is absent or the eyes do not close completely, the cornea may become dry and irritated. Corneal abrasion can occur. Taping the eye closed will prevent injury. Having the client wear eyeglasses or cleaning the eyelid will not protect the cornea from dryness or irritation. Artificial tears instilled once per shift are not frequent enough for preventing dryness.

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Question OF The Day: Neurosensory Disorders

Q. A nurse, a licensed practical nurse (LPN), and a nursing assistant are caring for a group of clients. The nurse asks the nursing assistant to check the pulse oximetry level of a client who underwent laminectomy. The nursing assistant reports that the pulse oximetry reading is 89%. The client Kardex contains an order for oxygen application at 2 L/min should the pulse oximetry level fall below 92%. The nurse is currently assessing a postoperative client who just returned from the postanesthesia care unit. How should the nurse proceed?

A. Immediately go the client's room and assess vital signs, administer oxygen at 2 L/minute, and notify the physician.
B. Ask the nursing assistant to notify the physician of the low pulse oximetry level.
C. Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy.
D. Complete the assessment of the new client before attending to the client who underwent laminectomy.

Correct Answer: C
Explanation: Because it's important to get more information about the client with a decreased pulse oximetry level, the nurse should ask the LPN to obtain vital signs and administer oxygen as ordered. The nurse must attend to the newly admitted client without delaying treatment to the client who is already in her care. The nurse can effectively do this by delegating tasks to an appropriate health team member such as an LPN. The nurse doesn't need to immediately attend to the client with a decreased pulse oximetry level; she may wait until she completes the assessment of the newly admitted client. The physician doesn't need to be notified at this time because an order for oxygen administration is already on record.

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Question Of The Day: Musculoskeletal Disorders

Q. A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position?

A. Head of the bed elevated 45 degrees
B. Prone
C. Supine with feet raised
D. Supine with the head lower than the trunk

Correct Answer: A
Explanation: After a myelogram, positioning depends on the dye injected. When a water-soluble dye such as metrizamide is injected, the head of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. The prone and supine positions are contraindicated when a water-soluble contrast dye is used. The client should be positioned supine with the head lower than the trunk after an air-contrast study.

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Question Of The Day: Endocrine and Metabolic Disorders

Q. A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

A. Administer half of the client's typical morning insulin dose as ordered.
B. Administer an oral antidiabetic agent as ordered.
C. Administer an I.V. insulin infusion as ordered.
D. Administer the client's normal daily dose of insulin as ordered.

Correct Answer: A
Explanation: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll experience hypoglycemia. Therefore, the nurse should administer half the daily insulin dose as ordered. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

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Question Of The Day: Gastrointestinal Disorders

Q. The comatose victim of the car accident is to have a gastric lavage. Which of the following positions would be most appropriate for the client during this procedure?

A. Lateral.

B. Supine.

C. Trendelenburg's.

D. Lithotomy.

Correct Answer: A

Explanation: An unconscious client is best positioned in a lateral or semiprone position because these positions allow the jaw and tongue to fall forward, facilitate drainage of secretions, and prevent aspiration. Positioning the client supine carries a major risk of airway obstruction from the tongue, vomitus, or nasopharyngeal secretions. Trendelenburg's position, with the head lower than the heart, decreases effective lung volume and increases the risk of cerebral edema. The lithotomy position has no purpose in this situation.

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Question Of The Day: Postpartum Period

Q. The nurse is assessing a client at her postpartum checkup 6 weeks after a vaginal delivery. The mother is bottle feeding her baby. Which client finding indicates a problem at this time?

A. Firm fundus at the symphysis.
B. White, thick vaginal discharge.
C. Striae that are silver in color.
D. Soft breasts without milk.

Correct Answer: A
Explanation: By 4 to 6 weeks postpartum, the fundus should be deep in the pelvis and the size of a nonpregnant uterus. Subinvolution, caused by infection or retained placental fragments, is a problem associated with a uterus that is larger than expected at this time. Normal expectations include a white, thick vaginal discharge, striae that are beginning to fade to silver, and breasts that are soft without evidence of milk production (in a bottle-feeding mother).

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Question Of The Day: Intrapartum Period

Q. A client with Rh isoimmunization gives birth to a neonate with an enlarged heart and severe, generalized edema. The neonate is immediately transferred to the neonatal intensive care unit. Which nursing diagnosis is most appropriate for the client?

A. Ineffective denial related to a socially unacceptable infection
B. Impaired parenting related to the neonate's transfer to the intensive care unit
C. Deficient fluid volume related to severe edema
D. Fear related to removal and loss of the neonate by statute

Correct Answer: B
Explanation: Because the neonate is severely ill and needs to be placed in the neonatal intensive care unit, the client may have a nursing diagnosis of Impaired parenting related to the neonate's transfer to the neonatal intensive care unit. (Another pertinent nursing diagnosis may be Compromised family coping related to lack of opportunity for bonding.) Rh isoimmunization isn't a socially unacceptable infection. This condition causes an excess fluid volume (not deficient) related to cardiac problems. Rh isoimmunization doesn't lead to loss of the neonate by statute.

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Question Of The Day: Antepartum Period

Q. A client has an episiotomy to widen her birth canal. Birth extends the incision into the anal sphincter. This complication is called:

A. a first-degree laceration.
B. a second-degree laceration.
C. a third-degree laceration.
D. a fourth-degree laceration.

Correct Answer: C

Explanation: Birth may extend an episiotomy incision to the anal sphincter (a third-degree laceration) or the anal canal (a fourth-degree laceration). A first-degree laceration involves the fourchette, perineal skin, and vaginal mucous membranes. A second-degree laceration extends to the fasciae and muscle of the perineal body.

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Question Of The Day: Psychotic Disorders

Q. A client has refused to take a shower since being admitted 4 days earlier. He tells a nurse, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?

A. Dismantling the showerhead and showing the client that there is nothing in it
B. Explaining that other clients are complaining about the client's body odor
C. Asking a security officer to assist in giving the client a shower
D. Accepting these fears and allowing the client to take a sponge bath

Correct Answer: D
Explanation: By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Because these fears are real to the client, providing a demonstration of reality by dismantling the shower head wouldn't be effective at this time. Explaining that other clients are complaining about his body odor or asking a security officer to assist in giving the client a shower would violate the client's rights by shaming or embarrassing him.

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Question Of The Day: Mood, Adjustment, and Dementia Disorders

Q. The major goal of therapy in crisis intervention is to:

A. withdraw from the stress.
B. resolve the immediate problem.
C. decrease anxiety.
D. provide documentation of events.

Correct Answer: B



Explanation: During a period of crisis, the major goal is to resolve the immediate problem, with hopes of getting the individual to the level of functioning that existed before the crisis or to a higher level of functioning. Withdrawing from stress doesn't address the immediate problem and isn't therapeutic. The client's anxiety will decrease after the immediate problem is resolved. Providing support and safety are necessary interventions while working toward accomplishing the goal. Documentation is necessary for maintaining accurate records of treatment; it isn't a major goal.

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